Provider Demographics
NPI:1831277300
Name:ZETTEL, JAMES J (PHD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:J
Last Name:ZETTEL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7519 MILLIES RUN RD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:TX
Mailing Address - Zip Code:77316-6805
Mailing Address - Country:US
Mailing Address - Phone:281-203-3953
Mailing Address - Fax:866-843-4145
Practice Address - Street 1:7519 MILLIES RUN RD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:TX
Practice Address - Zip Code:77316-6805
Practice Address - Country:US
Practice Address - Phone:281-203-3953
Practice Address - Fax:866-843-4145
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24752103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX123555806Medicaid
TX86459AOtherBLUE CROSS BLUE SHIELD
TX123555801Medicaid
TX123555803Medicaid
TX680013245OtherRAIL ROAD
TX82931POtherBLUE CROSS BLUE SHIELD
TX123555805Medicaid
TX8B1507Medicare ID - Type UnspecifiedGALVESTON
TX82931PMedicare ID - Type UnspecifiedALL OTHER COUNTIES
TX86459AOtherBLUE CROSS BLUE SHIELD
TX83170PMedicare ID - Type UnspecifiedBRAZORIA